It does not arise from the aforementioned provision that treatment and care in social care institutions are
provided only the case of a concession. The provision is clear: compulsory health insurance gives full and
unconditional right to treatment and care to all insured persons. According to the Ombudsman’s assessment,
the ZZZS’s interpretation regarding the concession requirement has no legal basis in the Health Care and
Health Insurance Act. We believe that the discrimination pointed out by the complainant was not due to the
Act, but to a misinterpretation.
2.13
SOCIAL MATTERS
Regarding the foregoing, we determined that neither legal amendments nor a review of constitutionality due
to a lacuna were needed to resolve the issue. In our opinion, the Act provides a sufficient legal basis for the
payment of performed health services subject to compulsory health insurance. To avoid future complications,
we propose that the issue be fully clarified in the new Act.
CASES CONSIDERED
RESOLVED AND FOUNDED
2015
Index
15/14
287
231
80.5
201
41
20.4
114
91
79.8
85
17
20
13.2 Social services
18
21
116.7
16
3
18.8
13.3 Institutional care
52
46
88.5
42
12
28.6
13.4 Poverty - general
19
20
105.3
18
3
16.7
13.5 Violence - anywhere
17
9
52.9
9
0
0
13.6 Other
67
44
65.7
31
6
19.4
13. Social security
13.1 Social benefits and assistance
NO. OF
RESOLVED
NO. OF
FOUNDED
PERCENTAGE OF
FOUNDED AMONG
RESOLVED
2014
FIELD OF WORK
2.13 SOCIAL MATTERS
2.12 HEALTH CARE AND HEALTH INSURANCE
Act is an individual right of citizens for which they have to pay an insurance premium and as such it cannot be
further burdened.
Surprisingly, the number of complaints referring to social security decreased by almost 20 per cent compared
to 2014, whereas the number of complaints involving social services increased significantly, including general
issues regarding poverty. In our opinion, such results were not due to citizens’ social security improving, but
the increasing apathy of individuals whose many years of efforts to improve their standard of living have failed
to bear fruit. Certain authorities, to which people refer regarding their problems, do not respond to the letters
they receive (which is a violation of the principle of good administration) and other competent authorities delay
their decision making (more on this below).
We accept the fact that the reduction in the number of complaints occurred also because people recognise
that the Ombudsman cannot help individuals financially or influence the competent authorities to allocate
assistance while bypassing regulations. Many complainants receive suitable expert information and advice by
phone, which certainly helps reduce the number of complaints. Our staff’s work was organised in a way that
enabled expert assistants responsible for certain fields to provide basic information by phone, and they can
thus advise complainants to instigate suitable procedures or contact the relevant authorities. The fact that
one-fifth of complaints relating to social security were founded is still of great concern (27.7 per cent in 2014),
and as much as 28.6 per cent concerning institutional care.
In the 2014 annual report, we proposed the adoption of measures to provide fast and qualitative information to
citizens on various ways of claiming social rights (recommendation no. 95). This year, we discovered that those
in need of help are still not given comprehensive information about all the options available to them. State
aid for citizens frequently depends on an expert worker at a social work centre, who in certain cases informs
individuals in advance on the inappropriateness of filing certain applications. The decision of individuals about
what assistance they should seek is their alone, and expert workers must assist them to do so and furnish
them with all the information they need. We thus proposed to the Ministry of Labour, Family, Social Affairs and
134
ANNUAL REPORT OF THE HUMAN RIGHTS OMBUDSMAN OF THE REPUBLIC OF SLOVENIA FOR 2015
ANNUAL REPORT OF THE HUMAN RIGHTS OMBUDSMAN OF THE REPUBLIC OF SLOVENIA FOR 2015
135
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